Department of Neurology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France.
Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France.
BMJ Case Rep. 2020 Aug 24;13(8):e235668. doi: 10.1136/bcr-2020-235668.
A 67-year-old woman with a history of smoking and cardiovascular risk factors was admitted to the emergency room for uncontrolled diabetes, loss of appetite, nausea, significant weight loss and asthenia. The initial investigation, including cerebral and gastrointestinal explorations, were normal. One month later, she started presenting severe asymmetric proprioceptive ataxia of the lower extremities. She also reported paresthesia and neuropathic pain in both feet and ankles. A positron emission tomography (PET)-scanner showed a hypermetabolic nodule in the right lung. The neurological symptoms were attributed to paraneoplastic sensory and dysautonomic neuropathy, even though the bronchoscopic biopsies came back negative at first. Anti-Hu, anti-CV2/CRMP5 and anti-SOX1 antibodies were documented. Due to the severity and rapid progression of symptoms (from the lower to the upper limbs), corticosteroids, intravenous immunoglobulins and immunosuppressants were introduced prior to biopsies revealing a small-cell lung cancer. Despite these treatments and antineoplastic chemotherapy, her status deteriorated rapidly.
一位 67 岁的女性，有吸烟史和心血管危险因素，因无法控制的糖尿病、食欲不振、恶心、明显体重减轻和乏力而被收入急诊室。初步检查包括脑部和胃肠道检查均正常。一个月后，她开始出现严重的不对称性下肢本体感觉共济失调。她还报告双脚和脚踝有感觉异常和神经病理性疼痛。正电子发射断层扫描（PET）显示右肺有一个高代谢结节。神经症状归因于副肿瘤感觉和自主神经神经病，尽管支气管镜活检最初呈阴性。后来检测到抗 Hu、抗 CV2/CRMP5 和抗 SOX1 抗体。由于症状的严重程度和快速进展（从下肢到上肢），在活检显示小细胞肺癌之前，给予了皮质类固醇、静脉注射免疫球蛋白和免疫抑制剂。尽管进行了这些治疗和抗肿瘤化疗，她的病情仍迅速恶化。
